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Randomized Controlled Trial
. 2016 Feb 19:14:34.
doi: 10.1186/s12916-016-0577-7.

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi

Hendramoorthy Maheswaran  1   2 , Stavros Petrou  3 , Peter MacPherson  4   5 , Augustine T Choko  6 , Felistas Kumwenda  6 , David G Lalloo  6   5 , Aileen Clarke  3 , Elizabeth L Corbett  6   7
Affiliations
Randomized Controlled Trial

Cost and quality of life analysis of HIV self-testing and facility-based HIV testing and counselling in Blantyre, Malawi

Hendramoorthy Maheswaran et al. BMC Med. .

Abstract

Background: HIV self-testing (HIVST) has been found to be highly effective, but no cost analysis has been undertaken to guide the design of affordable and scalable implementation strategies.

Methods: Consecutive HIV self-testers and facility-based testers were recruited from participants in a community cluster-randomised trial ( ISRCTN02004005 ) investigating the impact of offering HIVST in addition to facility-based HIV testing and counselling (HTC). Primary costing studies were undertaken of the HIVST service and of health facilities providing HTC to the trial population. Costs were adjusted to 2014 US$ and INT$. Recruited participants were asked about direct non-medical and indirect costs associated with accessing either modality of HIV testing, and additionally their health-related quality of life was measured using the EuroQol EQ-5D.

Results: A total of 1,241 participants underwent either HIVST (n = 775) or facility-based HTC (n = 446). The mean societal cost per participant tested through HIVST (US$9.23; 95 % CI: US$9.14-US$9.32) was lower than through facility-based HTC (US$11.84; 95 % CI: US$10.81-12.86). Although the mean health provider cost per participant tested through HIVST (US$8.78) was comparable to facility-based HTC (range: US$7.53-US$10.57), the associated mean direct non-medical and indirect cost was lower (US$2.93; 95 % CI: US$1.90-US$3.96). The mean health provider cost per HIV positive participant identified through HIVST was higher (US$97.50) than for health facilities (range: US$25.18-US$76.14), as was the mean cost per HIV positive individual assessed for anti-retroviral treatment (ART) eligibility and the mean cost per HIV positive individual initiated onto ART. In comparison to the facility-testing group, the adjusted mean EQ-5D utility score was 0.046 (95 % CI: 0.022-0.070) higher in the HIVST group.

Conclusions: HIVST reduces the economic burden on clients, but is a costlier strategy for the health provider aiming to identify HIV positive individuals for treatment. The provider cost of HIVST could be substantially lower under less restrictive distribution models, or if costs of oral fluid HIV test kits become comparable to finger-prick kits used in health facilities.

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Figures

Fig. 1
Fig. 1
Recruitment of HIV testers by study clusters and location of HIV testing. QECH Queen Elizabeth Central Hospital
Fig. 2
Fig. 2
Linkage into HIV treatment after HIV testing in those eligible for assessment. ART Anti-retroviral therapy, QECH Queen Elizabeth Central Hospital. *Completed CD4 measurement or WHO stage 3 or 4, **Data from main trial. For logistical reasons, individuals assessed and initiated on ART through the home-based option were not captured in this cohort
See this image and copyright information in PMC

References

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